Evaluation of maxillary sinus findings after dental implant and sinus floor augmentation procedures with cone-beam computed tomography.

BACKGROUND: To assess maxillary sinus findings using dental volumetric tomography before and after surgery in patients with dental implants in the maxillary posterior region with or without sinus floor elevation due to insufficient bone height. MATERIALS AND METHODS: Cone-beam computerized tomography images taken for surgical planning before implantation and controlling after implantation were reviewed in 50 patients applied to the Department of Oral, Dental and Maxillofacial Surgery and Radiology of Dentistry Faculty at Ondokuz Mayis University. Maxillary sinus diseases (focal mucosal thickening, polyp, mucous retention cyst, sinusitis) were evaluated. The relationship between dental implant and sinus floor augmentation procedures and maxillary sinus findings was statistically evaluated using the Chi-square test and Wilcoxon rank test. RESULTS: In this study, 26 female (52%) and 24 male (48%) patients were examined. The mean age of all patients was 53.82 years (± 8.63). Focal mucosal thickening was most frequently observed in the study. There was no statistically significant correlation between implant applications and sinus pathologies with both internal and external elevation procedures and implant applications (P > 0.05). CONCLUSIONS: Sinus floor augmentation and dental implant applications seemed not to increase the risk of maxillary sinüs pathologies. However, it is suggested to carry out similar studies with more samples.

Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs.

STUDY OBJECTIVE: We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions. DESIGN: Retrospective multi-institution cohort (Canadian Task Force classification II-2). SETTING: Three tertiary cancer referral cancer centers. PATIENTS: Patients with endometrial and vulvar cancer undergoing lymph node evaluation. INTERVENTIONS: Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment. MEASUREMENTS AND MAIN RESULTS: Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins. CONCLUSIONS: Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.

Apelin-13 increased food intake with serum ghrelin and leptin levels in male rats.

In this study, we aimed to explain the role of apelin-13 on body weight, food and water intake with serum leptin, ghrelin, neuropeptid Y (NPY) and peptid YY (PYY) levels in male rat. Thirty-two Sprague-Dawley male rats were used for the study. The rats were injected SP (0.9 %) intraperitoneally (i.p) in the control group and 30 (AP30), 100 (AP100) and 300 (AP300) µg/kg apelin-13 in the study groups, respectively, 10 min before the transition to dark period, for 10 days. During the experimental period, with light and dark periods of food and water intake, body weights were recorded in rats. Rats were euthanized and serum samples were obtained. In serum samples leptin, ghrelin, NPY and PYY levels were measured with specific ELISA kit. Apelin-13 was increased body weights in all three (AP30, AP100 and AP300) groups compared with the control group. AP100 and AP300 groups had increased food intake in the dark and the cumulative period, but in the light period food intake values were not significantly increased (p > 0.05). As for the value of water intake, compared with the control group, all dose of apelin-13 increased water intake during the dark and the cumulative period. There was no significant change in water intake in the light period. On the other hand, compared with the control group, serum leptin levels were found to increase in the groups administered 100 and 300 µg/kg of apelin-13 (p < 0.05). Ghrelin levels were found high in all groups treated with apelin-13. Serum levels of NPY decreased only in the 300 µg/kg apelin-13 treated group (p 0.05). Apelin-13 increases body weight in rats as well as food and water intake (dark and cumulative period). Additionally, ghrelin can mediate the orexigenic effect of apelin-13 in the regulation of food intake (Fig. 4, Ref. 37).

Evaluation of traumatic dental injuries in a group of Turkish population.

BACKGROUND: Traumatic dental injuries (TDIs) are significant clinical problems that may have complex etiologies and may cause physical and physiological impairment. AIM: The aim of this study was to determine the demographic and clinical characteristics of TDIs in a group of Turkish subjects. MATERIALS AND METHODS: The prevalence of TDIs and the pattern of traumatized teeth were studied in relation to age, gender, cause, location, and type of injury. This study was carried out to include all age groups and teeth. TDIs were recorded using the World Health Organization classification modified by Andreasen et al. RESULTS: The prevalence of TDIs was found to be 4.4% (255 injured patients/5800 presented patients), and the injuries were most commonly observed in the age group of 11-20 years. Males were more affected than females (males, 153; females, 102). The most common cause of traumatic injury was falling (68.2%), and the most common place of trauma was outdoors (56.1%). 4, 7% of patients injured because of their systemic diseases. The most frequently injured teeth were the upper central incisors (primary teeth, 64.5%; permanent teeth, 72.5%), and the most common type of dental injury was uncomplicated crown fracture in both primary (63%) and permanent dentition (47%). CONCLUSION: In the surveyed population, the prevalence of TDIs was found to be low. However, the teacher and family of adolescents and the caregivers of patients with some systemic diseases like epilepsy should be warned about TDIs.

Increased oxidative stress in patients with essential thrombocythemia.

BACKGROUND: Essential thrombocythemia (ET) is a clonal disease in which thrombotic and hemorrhagic complications are common. Our aim in this study was to investigate whether oxidative stress in ET patients increased compared to healthy volunteers and to investigate whether there is a relationship between vascular events and oxidative status parameters in ET patients. PATIENTS AND METHODS: We determined the serum levels of oxidative status parameters, such as total oxidative status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and malondialdehyde (MDA) in ET patients. Forty-three ET patients (20 males, 23 females) and 20 healthy volunteers were enrolled. Oxidative status parameters of the patients were compared with those of the controls at time of diagnosis and at 6th-month follow-up. Additionally, oxidative status parameters of patients with ET with a history of vascular event were compared with patients without a vascular event history during diagnosis. RESULTS: Rises in TOS, OSI, and MDA were statistically significant in the patients group; however, the TAS value was significantly lower compared to the control group. Furthermore, TOS was significantly higher in patients with history of vascular event compared to the patients without such a history. Following therapy, OSI and MDA values were significantly reduced in the patient group compared to the pre-treatment values. CONCLUSIONS: Our findings reveal that although oxidative stress parameters were increased, compensative total antioxidant status was significantly reduced in ET patients. Furthermore, TOS values were significantly high in patients with a history of vascular event.

The relationship between serum tumor-associated trypsin inhibitor levels and clinicopathological parameters in patients with gastric cancer.

BACKGROUND: Tumor-associated trypsin inhibitor (TATI) is expressed with trypsinogen in tumors. We studied the clinical-pathologic association and significance of preoperative serum levels of TATI in gastric cancer patients. PATIENTS AND METHODS: Pre-treatment serum levels of TATI in patients with gastric cancer and healthy controls were analyzed by a specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Statistically significant differences were found in serum TATI levels between patients with gastric cancer and healthy controls (p < 0.0001). There was a significant relationship between the serum levels of TATI and clinicopathological parameters. However, serum levels of TATI were significantly higher in patients with an advanced T stage (T3) (p < 0.001), lymph node metastasis (p < 0.001) and an advanced TNM stage (stage III or IV; p < 0.001). CONCLUSIONS: Our study suggests that TATI may be used to identify potentially high-risk groups of upper gastric carcinoma. Elevated level of TATI was associated with progressive disease or advanced stage.

Comparison of the right and left laparoscopic live donor nephrectomies: a clinical case load.

BACKGROUND: The aim of the present study was to retrospectively compare the results of right- and left-laparoscopic donor nephrectomy (LDN) performed in our Center. PATIENTS AND METHODS: Two hundred and eight patients who were operated on between October 2010 and October 2011 were included. Of the patients, 65 underwent right-LDN and 143 underwent left-LDN. The groups were compared in terms of duration of surgery, warm ischemia time, postoperative complications, length of hospital stay, and donor outcomes. RESULTS: The mean duration of surgery was 144±19.7 min and 147.8±20.2 min in the right- and left-LDN groups, respectively. The mean warm ischemia times were 139.1±54.1 s and 141.5±37.9 in the right- and left-LDN groups, respectively. The mean length of hospital stay was 2.4±1.0 days for both groups. No major complications were observed in the groups. There was no significant difference between the groups in terms of donor outcomes. CONCLUSIONS: The right-LDN is approached cautiously because of short length of vein and the risk for thrombosis. The results of the present study demonstrated that the right-LDN is as safe and effective as the left-LDN.

Comparison of laparoscopic evaluation of hepatosteatosis with ultrasound findings.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by abnormal liver function because of lipid accumulation. NAFLD can range from simple fatty liver, which is usually harmless, to a more severe condition called non-alcoholic steatohepatitis (NASH), which involves inflammation, liver cell damage, cirrhosis, and liver cancer. Liver biopsy is considered the gold standard for diagnosing and staging hepatosteatosis, but it is an invasive and expensive procedure. Non-invasive methods, such as ultrasound, and magnetic resonance imaging (MRI), can provide useful information without the need for an invasive procedure. This study aimed to compare laparoscopic findings of hepatosteatosis with ultrasound data to create a classification that can identify individuals with NASH in operated patients. PATIENTS AND METHODS: 120 patients who applied to the General Surgery Department of Istinye University Faculty of Medicine between 06/2022 and 12/2022 were included in the study. They were evaluated for hepatosteatosis with preoperative ultrasound. Demographic, physical examination (BMI), laboratory, and radiological findings of the patients were recorded retrospectively. In addition, laparoscopy video recordings were reviewed retrospectively, and the findings were evaluated. Statistical analysis of the findings was made. The p-value was calculated using the Chi-square test; p-value <0.05 was considered statistically significant. RESULTS: The mean age of 120 patients was 39.04 years, the mean BMI was 34.9 kg/m², and 63.3% of them were female patients. Cholecystectomy was performed in 60 of 120 patients, and sleeve gastrectomy in 60 of them. It has been observed that there is a high correlation between the ultrasound grade and the laparoscopic stage of hepatosteatosis (r=0.849) (p<0.05). CONCLUSIONS: Laparoscopy results to be an effective method in the diagnosis and classification of NASH.

Ultrasonography in the evaluation of midpalatal suture in surgically assisted rapid maxillary expansion.

Surgically assisted rapid maxillary expansion (SARME), which combines orthodontics and surgery, is a well-established therapy for transverse maxillary hypoplasia in adults after sutural closure or completion of skeletal maturation. X-rays are usually the preferred monitoring technique for this treatment. Recently, ultrasound scanning has been used successfully in the follow-up of patients undergoing distraction osteogenesis. In this study, ultrasonography (US) was used in the evaluation of bone callus formation in the midpalatal suture in 3 patients undergoing SARME. For each patient, US was performed immediately after active expansion, at 2 and 4 months of the expansion period, at the removal of the expander 6 months later, and at 2 months after expander removal. The results indicated that US might be a useful and accurate method to assess bone fill in the midpalatal suture in patients undergoing SARME. However, further studies are necessary to clarify the US scores in a larger patient group undergoing SARME.

A single-center kidney transplantation experience in children with low weight: is low weight a contraindication?

OBJECTIVE: Kidney transplantation (KT) might be difficult for underweight kids (under 15 kg). Our goal was to convey information on KT in underweight children. PATIENTS AND METHODS: The study's target population consisted of children (age 18) weighing 15 kg or fewer who received KT at our facility between January 2018 and June 2021. A retrospective analysis was performed on demographic and clinical data, including age, gender, primary disease, pretransplant dialysis status, recipient weight, recipient body mass index (BMI), surgical approach type (intraperitoneal/extraperitoneal), complications, graft status (functioning/failed), patient survival, and immunological data. RESULTS: There were 94 pediatric KTs completed. Thirty-three patients were included when the selection criteria were applied. The mean recipient weight was 11.45 [6.7-15] kg, and the average patient age was 3.36 [1-7]. Three (9.9%) patients had kidney transplants from dead adult donors, whereas thirty (90.1%) patients underwent live donor kidney transplantation (LDKT). While the intraperitoneal (IPA) technique was used in 19 cases, the extraperitoneal (KT) strategy was used on 14 patients (EPA). The donor BMI was 28.24 [19.6-42] kg/m2, and the mean donor weight was 78.13 [55-109] kg. Bridectomy was necessary because five individuals experienced ileus. IPA was performed in each of these patients during LDKT. Following IPA, a 2-year-old patient with a BMI of 16 kg/m2 had renal allograft compartment syndrome and required graft nephrectomy. CONCLUSIONS: Pediatric patients weighing 15 kg or fewer can get kidney transplants successfully. Gastrointestinal problems are relatively uncommon with EPA, even though there is no agreement on the best surgical strategy.

Circulating levels of VEGF family and their receptors in hepatocellular carcinoma.

To analyze the serum levels and prognostic significance of vascular endothelial growth factor (VEGF) family (VEGF-A, -C and -D) and their receptors (VEGFR-1 and -2) in patients with hepatocellular carcinoma. The serum levels of VEGF family members were measured in 56 control subjects and 68 patients with hepatocellular carcinoma using an enzyme-linked immunosorbent assay (ELISA). These measurements were correlated with clinic pathological features. The serum levels of VEGF-A and its receptor, VEGFR-1, were significantly higher in patients with hepatocellular carcinoma than in controls (p < 0.001). There was no significant difference in serum levels of VEGF-C and VEGFR-2 between patients and controls. VEGF-A levels were associated with advanced tumor stage and presence of metastases. VEGFR-1 was associated with metastases, advanced overall stage, tumor differentiation. VEGFR-2 levels were associated with poor tumor differentiation. Serum VEGF levels are significantly in the same cohort of patients with variable clinic pathological features and prognostic values. The measurement of VEGF-A and its VEGFR-1 levels in sera may reflect the development of tumor, metastasis and angiogenesis (Tab. 2, Ref. 20).

Analysis of vitamin D receptor gene polymorphisms in patients with chronic periodontitis.

BACKGROUND & OBJECTIVE: Genetic polymorphisms in the vitamin D receptor (VDR) gene are related to bone mineral density, bone turnover, and diseases with bone loss. Alveolar bone loss is a key feature in periodontitis. The aim of this study was to determine whether severe generalized chronic periodontitis (CP) in a Turkish population was associated with polymorphisms in the VDR gene. METHODS: Samples of venous blood and DNA were obtained from 72 patients with severe generalized chronic periodontitis and 102 healthy controls. The polymorphic regions were amplified using PCR followed by digestion with restriction enzymes BsmI A/G(rs1544410), ApaI G/T(rs11168271), TaqI T/C(rs731236), and analyzed electrophoretically. Genotype and allele frequencies were calculated. RESULTS: There were no statistically significant differences in the frequencies of VDR BsmI, ApaI, TaqI genotypes between the CP patients and healthy controls. The GTT haplotype, constructed from the three adjacent restriction fragment length polymorphisms was found to be over-represented among CP cases. This corresponded an OR of 2.4 (95% confidence interval, 1.12-5.18) for heterozygous carriers and 2.27 (95% confidence interval, 0.95-5.4) for homozygous carrier of the risk haplotype. INTERPRETATION & CONCLUSION: The present findings indicated that BsmI, ApaI, TaqI polymorphisms of the VDR gene were not associated with the severe generalized CP in the studied Turkish patients. Moreover, the VDR genotypes based on haplotype analysis may be associated with chronic periodontitis. In the future, diagnostic periodontal risk assessments like polymorphisms may be useful in detection of individuals susceptible for periodontitis.

Association of interleukin-10 gene polymorphisms with severe generalized chronic periodontitis.

BACKGROUND: Interleukin-10 (IL-10), an anti-inflammatory cytokine, plays a role in periodontal disease by inhibiting synthesis of proinflammatory cytokines and stimulating protective antibody production. Genetic polymorphisms in the IL-10 gene might be useful as a marker to diagnose susceptibility to periodontitis. Therefore, the aim of this study was to investigate the association between IL-10 gene polymorphisms and severe generalized chronic periodontitis (CP) in a Turkish population. METHODS: Samples of venous blood and DNA were obtained from 75 patients with severe generalized CP and 73 healthy subjects. The IL-10 promoter sequences at positions -597 and -824 were amplified by polymerase chain reaction, and polymorphisms were detected by restriction enzyme cleavage. Genotype and allele frequencies were calculated, and data were analyzed using the chi(2) test. RESULTS: There was a statistically significant difference in frequencies of genotypes (AA/CC + CA: P = 0.00007, odds ratio = 12.37, 95% confidence intervals = 2.74 to 7.77; CC/CA + AA: P = 0.001, odds ratio = 3.05, 95% confidence intervals = 1.47 to 6.33) and alleles (P = 0.0002, odds ratio = 2.61, 95% confidence intervals = 1.52 to 4.51) at position -597 C to A between patients with severe generalized CP and healthy controls, whereas there was no significant difference in genotypes and allele frequencies at position -824 C to T between patients with CP and healthy subjects. CONCLUSION: Within the limitations of sample selection and number, the IL-10 gene polymorphism at position -597 seems to be associated with severe generalized CP.

Definition, classification and retrospective analysis of photostimulable phosphor image artefacts and errors in intraoral dental radiography.

OBJECTIVES: To detect and determine image error and artefact types in intraoral radiographs obtained with photostimulable phosphor (PSP) technology, place them in an appropriate classification and retrospectively analyze the PSP-specific image errors and artefacts. The causes and solutions of PSP-specific errors and artefacts have also been discussed. METHODS: The radiographic database of Ondokuz Mayis University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, was used for this study. Different types of image errors and artefacts observed on intraoral radiographs during 2014-15 were detected and defined. A total of 2100 intraoral radiographs were individually evaluated for the distribution of PSP-specific image artefacts. RESULTS: There were 34 image error and artefact types detected and classified into 4 groups according to the causative factors. The most common PSP-specific image artefacts were found in fading with a ratio of 44.1% for the ambient light-related group, peeling of the plate borders with a ratio of 53.4% for the PSP plate-related group and straight line with a ratio of 42.2% for the scanner-related group. CONCLUSIONS: The determination and definition of the image errors and artefacts with clarification of their causes and solutions are important for the improvement of radiographic quality and the reduction of the retake ratio.

Association of matrix metalloproteinase-9 promoter gene polymorphism with chronic periodontitis.

BACKGROUND: Matrix metalloproteinases (MMPs) are related to tissue destruction and remodeling events in periodontal diseases. A single nucleotide polymorphism in the promoter region of human MMP-9 gene is associated with the risk of some inflammatory diseases. Therefore, the aim of this study was to investigate the association between MMP-9 promoter polymorphism and severe generalized chronic periodontitis in a Turkish population. METHODS: Samples of venous blood and DNA were obtained from 70 severe generalized chronic periodontitis patients and 70 healthy subjects. The alleles of the C/T polymorphism at position -1562 in the promoter region of the MMP-9 gene were distinguished by cutting with the SphI restriction enzyme. Genotype and allele frequencies were calculated, and data were analyzed by the chi2 test. RESULTS: There was a significant difference in MMP-9 genotypes between chronic periodontitis patients and healthy controls. The odds ratios for the CT genotype and the combination of CT and TT genotypes were 0.4 (95% confidence interval, 0.17 to 0.93; P=0.02) and 0.37 (95% confidence interval, 016 to 0.85; P=0.01) relative to the subjects with the CC genotype, respectively. CONCLUSION: MMP-9 promoter gene polymorphism seems to be associated with severe generalized chronic periodontitis.

Concrescence of a mandibular third molar and a supernumerary fourth molar: report of a rare case.

Concrescence represents a rare developmental anomaly in which two fully formed teeth are joined along the root surfaces by cementum. Maxillary molars are the teeth most frequently involved, especially a third molar and a supernumerary tooth. Very few cases have been reported about the concrescence of a third molar and a supernumerary tooth. According to our current knowledge, this case report is the first in the literature in which concrescence is observed between a third molar and a supernumerary fourth molar in the mandible.

Benign cementoblastoma: a case report.

In the past the benign cementoblastoma was recognized in the World Health Organization's classification of odontogenic tumours as one of the cementoma neoplasias. Recently the benign cementoblastoma is included into Mesenchyme and/or odontogenic ectomesenchyme, with or without odontogenic epithelium odontogenic tumours. Benign cementoblastoma has characteristic radiologic and microscopic features and it appears to be fused to the tooth roots. Symptoms may be totally absent, and when they do occur, pain and swelling are frequent findings. The final diagnosis is usually made histopathologically, but the clinical diagnosis is comparatively easy if it is examined radiographically. The tumour has unlimited growth potential. Most frequently tends to be associated with an erupted permanent tooth, most often the first molar: rarely has an association with an impacted or partial impacted tooth been reported. This case represents a case of benign cementoblastoma associated with a partially impacted mandibular third molar.

The evaluation of palatal bone thickness for implant insertion with cone beam computed tomography.

The palate is an alternative anchoring site for orthodontic implants and screws. The use of osseointegrated implants in the intermaxillary suture has recently been described as a fast, effective, and low-cost technique for patients with atrophy of the maxillae. The aim of this study was to use cone beam computed tomography (CBCT) to evaluate the thickness of the bone surrounding the intermaxillary suture in relation to the insertion of osseointegrated implants. CBCT images of 144 patients (72 males, 72 females) aged 35-86 years were evaluated. The vertical bone height of the intermaxillary suture was measured using coronal and sagittal Images 5, 10, 15, 20, and 25 mm posterior to the incisive foramen. The mean bone thicknesses from the anterior to the posterior region were 5.59, 4.38, 3.91, 3.95, and 3.94 mm, respectively. Bone thickness was significantly different among the five anteroposterior areas of the suture, but there were no significant differences between males and females, or among age groups. The highest part of the intermaxillary suture was in the anterior region. Three-dimensional imaging is recommended to accurately identify palate bone thickness for implant placement.

An unusual presentation of talon cusp: a case report.

The talon cusp is a relatively rare dental developmental anomaly characterised by cusp-like projections, usually observed on the lingual surface of the affected tooth. Normal enamel covers the cusp and fuses with the lingual aspect of the tooth. The cusp may or may not contain an extension of the pulp. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. This study reports the unusual case of a 47-year-old female with a taloned tooth on the right maxillary central incisor possessing both lingual and labial talons, with an x-shaped appearance when viewed occlusally.

Changes in knot-holding capacity of sliding knots in vivo and tissue reaction.

OBJECTIVES: To evaluate and compare the in vivo strength, knot efficiency, and knot security of 4 types of sliding knots, and to assess tissue reaction to study the effect of knot configuration, knot volume, and suture size. DESIGN: Randomized trial. SETTING: Experimental Medical Research Institute, Istanbul, Turkey. SUBJECTS: Wistar rats. INTERVENTION: To assess the tissue reaction, a midline laparotomy incision was made in 112 rats and sutured with various interrupted knots in silk and nylon sutures of 2/0 and 4/0 (United States Pharmacopeia) sizes. Suture loops were implanted in subcutaneous pouches in the rat abdomen. Sutures were all extracted at days 4, 7, 11, and 20 to determine their knot-holding capacity. MAIN OUTCOME MEASURES: Knot efficiency and percentage decrease in knot-holding capacity were examined. Knot, tissue reaction, and inflammatory sheath volumes were measured. RESULTS: The 4/0 knots lost more strength than the 2/0 knots. The alternating knots with different patterns were more efficient and secure than the simple alternating ones. The alternating parallel knot was found to be unreliable. The tissue response to all the knots, except 2/0 nylon, was similar. The inflammatory sheath volume varied depending on the knot volume, suture size, and knot configuration. CONCLUSION: The use of alternating sliding knots with different patterns is recommended to replace simple alternating sliding knots.